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Clinical outcomes of coronary revascularization without cardiopulmonary bypass
Sotiris C Stamou1, Albert J Pfister, Kathleen A Jablonski
1Section of Cardiac Surgery, Georgetown University Hospital, Washington, DC, USA.
Insights
Coronary artery bypass without cardiopulmonary bypass (OPCAB) demonstrates favorable long-term survival rates. Advanced age and reduced ejection fraction are key predictors of mortality following OPCAB surgery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery bypass without cardiopulmonary bypass (OPCAB) avoids complications associated with cardiopulmonary bypass.
- Long-term outcomes of OPCAB remain largely uncharacterized.
Purpose of the Study:
- To investigate long-term mortality, stroke, myocardial infarction, and reintervention rates after OPCAB.
- To identify predictors of late mortality in OPCAB patients.
Main Methods:
- Retrospective analysis of 857 consecutive OPCAB patients (May 1987 - March 1999).
- Long-term follow-up obtained for 86% of eligible patients.
- Cox regression analysis used to identify risk factors for late mortality.
Main Results:
- Median follow-up of 2.2 years (range 0-13.3 years).
- Actuarial survival was 89%; event-free survival was 76%.
- Independent predictors of late mortality included age >75 years and ejection fraction <35%.
Conclusions:
- OPCAB is associated with low mortality and clinical event rates.
- Advanced age and depressed ejection fraction independently predict increased mortality post-OPCAB.
Objective:
Coronary artery bypass without cardiopulmonary bypass (OPCAB) eliminates the complications related to cardiopulmonary bypass. However, the long-term outcomes of this procedure are largely unknown.
Methods:
We sought to investigate the rates of late mortality, stroke, acute myocardial infarction, and target vessel reintervention after OPCAB in a consecutive series of 857 patients who underwent OPCAB between May 1987 and March 1999.
Results:
Long-term follow-up was obtained for 86% of eligible patients. Actuarial and event-free survival was 89% and 76%, respectively, for a median follow-up period of 2.2 years (range, 0-13.3 years). Risk factors for late mortality were identified with Cox regression analysis. In the multivariate analysis, patient age >75 years (odds ratio, 1.1; 95% confidence interval, 1.0-1.1; P =.01) and an ejection fraction <35% (odds ratio, 2.7; 95% confidence interval, 1.2-6.2; P =.02) emerged as independent predictors of late mortality.
Conclusion:
OPCAB is associated with a low mortality and clinical event rate. Advanced age and depressed ejection fraction may increase mortality after OPCAB.